In the performance of surgery and related procedures, sterile operating conditions are maintained by a surgical drape which covers the patient and the operating table. The surgical procedure is performed through a slit or preformed fenestration which is aligned with a desired surgical site. It is sometimes necessary to support and stabilize an instrument such as endoscope in an elevated position above the patient for long periods of time, with a portion of the instrument being inserted into the patient's abdominal cavity. An endoscope is a slender viewing tube which may be rigid or flexible, and which includes an optical lens system and a light source. The purpose of the endoscope instrument is to provide visual access into a body cavity, for example, the abdominal cavity, the knee, shoulder, bladder, uterus and bowel. A laparoscope is a type of endoscope which includes a rigid viewing tube for insertion through the abdominal wall.
It is necessary to vary the position of the instrument from time to time according to the needs of the surgical procedure. During a laparoscopic cholecystectomy (gall bladder removal), for example, an endoscope is inserted into the upper abdominal cavity which is inflated and pressurized with carbon dioxide by an insufflating machine. The endoscope is guided through a trocar sheath which serves as an interface port through the abdominal wall. By sliding the endoscope up and down the port, or rotating it in the desired direction, a view of the internal organs can be obtained by a video camera which is attached to the endoscope, and with the image being displayed on a video monitor.
The video camera also records the movement of other surgical instruments, for example, a grasper, a hook, a spatula, forceps and dissector, which are guided into and out of the abdominal cavity through one or more secondary surgical trocar sheaths. When the distal tip of the instrument appears on the video monitor, the surgeon guides it into place and controls its action and movement as displayed on the video monitor. It is usually necessary to re-position the endoscope from time to time to view the operative site so that the surgical instruments are positioned appropriately within the cavity to expose the organ or internal tissue for inspection, repair, dissection or excision.
The success of the laparoscopy procedure depends in part on the surgeon's ability to gauge spatial relationships as viewed on the video monitor, and to be able to easily adjust or reposition the endoscope as the procedure progresses. During gall bladder removal, for example, it may be necessary to re-position the endoscope and hold it in a desired orientation as the gall bladder duct is sealed by a surgical clip. Additionally, it may be necessary to re-position the endoscope while using an electrocautery instrument to excise the gall bladder from the underside of the liver. After the gall bladder organ has been severed, it is removed through an exit port. It is then necessary to reposition the endoscope to an upper midline port so that the surgeon can correctly position and operate a grasper instrument through a secondary trocar port.
Examples of procedures which may be performed or assisted by endoscopy include the following:
______________________________________ Diagnostic Tubal Sterilization Ablation Endo- metriosis Ovarian Biopsy Ovarian Cyst Aspi- Ovarian Cystectomy ration Ovarian Oophorectomy Laser Uterine Endocoagulation Nerve Ablation Presacral Neurecto- Salpingoplasty Salpingostomy my Salpingectomy Tubal Reanastomosis Myomectomy Pelvic Abscess Removal of foreign In Vitro Fertiliza- body (IUD) tion Hysterectomy Ovarian Torsion Multiple Peritoneal Biopsies Omentectomy Lymphadenectomy Lysis Bowel Adhe- sions Appendectomy Cholecystectomy Colectomy Hernia Repair Gonadectomy Nephrectomy ______________________________________
Other procedures which may be assisted by endoscopy include orthopedic knee surgery, orthopedic shoulder surgery, urological procedures, bowel procedures, and other gynecological procedures.